2018 年 1 巻 1 号 p. 40-49
Gastric cancer remains a major health concern worldwide, particularly in Asia. Surgery is the only curative treatment, and D2 gastrectomy is the standard therapy for resectable cases. Several clinical trials have been conducted in Japan to achieve higher cure rates via extended surgery; however, despite higher morbidity, none demonstrated prolonged survival. Against this background, minimally invasive surgical approaches that preserve gastric function and improve postoperative quality of life have been developed in recent years. For early gastric cancer, endoscopic resection and laparoscopic gastrectomy have achieved remarkable success even for later-stage cases. Long-term outcomes have been investigated in large-scale, randomized controlled trials. In addition, robot-assisted gastrectomy is now more common in clinical practice. S-1, an anti-tumor drug, is a key agent for treating gastric cancer and has resulted in dramatic improvements in survival. For locally advanced gastric cancer, patients are usually treated with surgery and adjuvant or neoadjuvant chemotherapy, and the efficacies of various regimens have been examined in many clinical trials. For unresectable or recurrent gastric cancer, new agents such as molecular-targeted agents and immune checkpoint inhibitors have emerged as notable treatments and are now being tested in numerous clinical trials. This review provides an update on gastric cancer treatment, highlighting current individualized strategies and future perspectives.
